Should we abandon corticosteroids during septic shock? No

Septicshockremainsthemostcommoncauseofdeathinthe intensive care unit, with mortality rates approaching50%. Current guidelines for the treatment of this syn-drome include consideration of therapy with stress(‘low’) doses of corticosteroids if the patient is poorlyrespondingtorepeated fluidchallengesand onvasopres-sor therapy [1 ]. The guidelines indicate that this shouldnot be tailored individually on the basis of an adreno-corticotrophic hormone (ACTH) test prior to start oftherapy. In contrast, prior studies [2,3] had suggestedthe concept of relative adrenal insufficiency (RAI) orcritical illness-related corticosteroid insufficiency(CIRCI), characterized by a subnormal response in cir-culating (total) cortisol upon a (supraphysiologic) ACTHstimulus and necessitating substitution therapy by stressdoses of hydrocortisone (with or without the mineral-ocorticoid fludrocortisone) to improve outcome. How-ever, the recent corticosteroid therapy of septic shock(CORTICUS) trial [4